Subcutaneous Uptake on 18F Florbetaben PET/CT: a Possible Immune-Induced Amyloid-Beta Deposition after COVID-19 Vaccination
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Subcutaneous Uptake on [18F]Florbetaben PET/CT:
a Possible Immune-Induced Amyloid-Beta
Deposition after COVID-19 Vaccination
Riccardo Laudicella ( riclaudi@hotmail.it )
University of Messina Department of Biomedical Dental Morphological and Functional Imaging
Sciences: Universita degli Studi di Messina Dipartimento di Scienze biomediche odontoiatriche e delle
immagini morfologiche e funzionali https://orcid.org/0000-0002-2842-0301
Irene Andrea Burger
Zurich University Hospital Department of Nuclear Medicine: UniversitatsSpital Zurich Klinik fur
Nuklearmedizin
Francesco Panasiti
University of Messina Department of Biomedical Dental Morphological and Functional Imaging
Sciences: Universita degli Studi di Messina Dipartimento di Scienze biomediche odontoiatriche e delle
immagini morfologiche e funzionali
Costanza Longo
University of Messina Department of Biomedical Dental Morphological and Functional Imaging
Sciences: Universita degli Studi di Messina Dipartimento di Scienze biomediche odontoiatriche e delle
immagini morfologiche e funzionali
Salvatore Scalisi
Istituto di Bioimmagini e Fisiologia Molecolare Unita Organizzativa di Supporto a Cefalu Consiglio
Nazionale delle Ricerche
Fabio Minutoli
University of Messina Department of Biomedical Dental Morphological and Functional Imaging
Sciences: Universita degli Studi di Messina Dipartimento di Scienze biomediche odontoiatriche e delle
immagini morfologiche e funzionali
Sergio Baldari
University of Messina Department of Biomedical Dental Morphological and Functional Imaging
Sciences: Universita degli Studi di Messina Dipartimento di Scienze biomediche odontoiatriche e delle
immagini morfologiche e funzionali
Luigi Maria Edoardo Grimaldi
Istituto di Bioimmagini e Fisiologia Molecolare Unita Organizzativa di Supporto a Cefalu Consiglio
Nazionale delle Ricerche
Pierpaolo Alongi
Page 1/5Istituto di Bioimmagini e Fisiologia Molecolare Unita Organizzativa di Supporto a Cefalu Consiglio
Nazionale delle Ricerche
Research Article
Keywords: Covid19, Amyloid, PET/CT, Alzheimer, Florbetaben, Vaccination
Posted Date: July 20th, 2021
DOI: https://doi.org/10.21203/rs.3.rs-665998/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
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Page 2/5Abstract
Introduction
Large-scale worldwide COVID-19 vaccination programs are being rapidly deployed, and high-risk patients
with comorbidity are now receiving the first doses of the vaccine. Physicians should be, therefore, aware
of new pitfalls associated with the current pandemic vaccination program, also in case of
[18F]Florbetaben PET/CT.
Case Presentation
We described the first image of [18F]Florbetaben PET/CT in the evaluation of a 70-year-old male with
suspicious Alzheimer disease and unclear history of heart disease. We detailed the diagnostic imaging
PET/CT workup with different findings.
Conclusion
In this case, [18F]Florbetaben PET/CT can demonstrate immune-induced findings associated with the
current COVID-19 pandemic vaccination programs.
Introduction
Large-scale worldwide COVID-19 vaccination programs are being rapidly deployed, and high-risk patients
with comorbidity are now receiving the first doses of the vaccine. Physicians should be, therefore, aware
of new pitfalls associated with the current pandemic vaccination program, also in case of
[18F]Florbetaben PET/CT.
Case Presentation
We report the case of a 70-year-old male who underwent [18F]Florbetaben PET/CT for suspected
Alzheimer disease (AD) with unclear history of heart disease (hypertensive disease and suspicious
cardiac amyloidosis) one-day-after the administration of the first dose of Pfizer-BioNTech COVID-19
vaccine in the right arm. A moderate amyloid burden on bilateral frontal and parietal brain cortex and
absence of cardiac beta-amyloid deposition were identified; however, subcutaneous uptake on the
vaccination site in the right arm’s deltoid region and focal uptake next to an ipsilateral axillary lymph
node were noted. Tracer injection was via the left antecubital fossa, hence not a potential cause.
[18F]Florbetaben MIP (A), PET (axial-B, coronal-G), CT (axial-C, coronal-E), PET/CT (axial-D, coronal-F)
images demonstrated ill-defined uptake in the right arm’s subcutaneous tissues (SUVmax 5.6; white-
arrows) and next to a possible right-axillar lymph node (SUVmax 4.75; yellow-arrows) evident on low-dose
CT scan without breathing control (red-arrows). We assume that the subcutaneous and the potential
lymph node uptake might be due to induced inflammation with peptides deposition, as amyloid-beta
peptides are involved in the systemic inflammatory process such as in the physiopathology of AD, and
Page 3/5chronic, low-level systemic inflammation may exacerbate the Aβ deposition [1–4]. Similar findings with
other radiopharmaceuticals were recently described [5, 6], but this is the first case to show that also
[18F]Florbetaben PET/CT can demonstrate immune-induced findings associated with the current COVID-
19 pandemic vaccination programs, being a potential finding on whole-body protocols for the
assessment in cardiac amyloidosis evaluation.
Conclusion
In this case, [18F]Florbetaben PET/CT can demonstrate immune-induced findings associated with the
current COVID-19 pandemic vaccination programs.
Declarations
Ethics approval and informed consent
All procedures performed involving the human participant were in accordance with the ethical standards
of the institutional and/or national research committee and with the 1964 Helsinki declaration and its
later amendments or comparable ethical standards. Informed consent was obtained from the patient.
Competing interests
The authors declare no competing interests.
Availability of data and material
Contact the corresponding author for data requests.
Funding
There is no source of funding.
References
1. Bucerius J, Barthel H, Tiepolt S, Werner P, Sluimer JC, Wildberger JE, Patt M, Hesse S, Gertz HJ,
Biessen EA, Mottaghy FM, Sabri O. Feasibility of in vivo 18F-florbetaben PET/MR imaging of human
carotid amyloid-β. Eur J Nucl Med Mol Imaging. 2017;44:1119–1128.
https://doi.org/10.1007/s00259-017-3651-2
2. Kokjohn TA, Van Vickle GD, Maarouf CL, Kalback WM, Hunter JM, Daugs ID, Luehrs DC, Lopez J,
Brune D, Sue LI, Beach TG, Castano EM, Roher AE. Chemical characterization of pro-inflammatory
amyloid-beta peptides in human atherosclerotic lesions and platelets. Biochim Biophys Acta.
2011;181:1508–1514. doi: 10.1016/j.bbadis.2011.07.004.
Page 4/53. Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. Acta Neuropathol.
1991;82:239–259. doi: 10.1007/BF00308809.
4. Oberlin LE, Erickson KI, Mackey R, Klunk WE, Aizenstein H, Lopresti BJ, Kuller LH, Lopez OL, Snitz BE.
Peripheral inflammatory biomarkers predict the deposition and progression of amyloid-β in
cognitively unimpaired older adults. Brain Behav Immun. 2021;21:S0889-1591. doi:
10.1016/j.bbi.2021.03.015.
5. Eifer M, Eshet Y. Imaging of COVID-19 vaccination at FDG PET/CT. Radiology. 2021;210030.
6. Nawwar AA, Searle J, Singh R, Lyburn ID. Oxford-AstraZeneca COVID-19 vaccination induced
lymphadenopathy on [18F]Choline PET/CT—not only an FDG finding. Eur J Nucl Med Mol Imaging
2021;4:1–2. https://doi.org/10.1007/s00259-021-05279-2
Figures
Figure 1
[18F]Florbetaben MIP (A), PET (axial-B, coronal-G), CT (axial-C, coronal-E), PET/CT (axial-D, coronal-F)
images demonstrated ill-defined uptake in the right arm’s subcutaneous tissues (SUVmax 5.6; white-
arrows) and next to a possible right-axillar lymph node (SUVmax 4.75; yellow-arrows) evident on low-dose
CT scan without breathing control (red-arrows).
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